In a study reported in the Journal of Clinical Oncology, Anita Y. Kinney, PhD, RN, and colleagues found that a phone-based tailored risk counseling and navigation intervention resulted in a higher proportion of patients with ovarian or high-risk breast cancers receiving cancer genetic risk assessment compared with a mailed targeted print education intervention or usual care.
As stated by the investigators, “Cancer genetic risk assessment is recommended for [patients] with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations.”
Anita Y. Kinney, PhD, RN
Study Details
In the trial, 641 patients with ovarian or high-risk breast cancer from statewide cancer registries in Colorado, New Jersey, and New Mexico were randomly assigned 1:1:1 to participate in the phone-based tailored risk counseling and navigation intervention (n = 212), the mailed targeted print intervention (n = 216), or usual care (n = 213). Patients in the phone-based tailored risk counseling and navigation intervention group received a mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call; patients in the targeted print group received the mailed educational brochure. Overall, 25.4% of patients identified as Hispanic and 5.9% as non-Hispanic Black; 17.5% lived in rural areas.
Key Findings
At 6 months, 18.7% of patients in the phone-based tailored risk counseling and navigation intervention group had received medically verified cancer genetic risk assessment—significantly higher rates than the mailed targeted print group (3.0%; odds ratio [OR] = 7.4, 95% confidence interval [CI] = 3.0–18.3, P < .0001) and the usual care group (2.5%; OR = 8.9, 95% CI = 3.4–23.5, P < .0001). There was no significant difference in cancer genetic risk assessment uptake for the mailed targeted print group vs the usual care group (OR = 1.2, 95% CI = 0.4–4.0, P = .767).
Among the total of 43 women who underwent medically verified cancer genetic risk assessment, 65% had both counseling and testing, 24% had testing only, and 12% had counseling only.
The most frequently cited barriers to counseling were lack of provider referral (33.7%) and cost concerns (26.5%). The most frequently cited barriers to testing were cost concerns (41.2%) and anticipated challenges in coping with results (14.0%).
The investigators concluded: “[A] phone-based tailored risk counseling and navigation intervention increased cancer genetic risk assessment uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase cancer genetic risk assessment among [patients] recruited from statewide cancer registries.”
Dr. Kinney, of Rutgers Cancer Institute of New Jersey, New Brunswick, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute and others. For full disclosures of the study authors, visit ascopubs.org.
